﻿<!DOCTYPE html>

<html lang="en" xmlns="http://www.w3.org/1999/xhtml">

<head>
    <meta charset="utf-8" />
    <title></title>
    <style type="text/css">
        * {
            margin: 0;
            padding: 0;
            font-size: 12px;
        }

        .wrapBox {
            width: 95%;
            margin: 0 auto;
        }

        body {
            font-family: SimSun !important;
            padding-top: 5px;
            padding-bottom: 10px;
        }

        p {
            margin: 0px;
            line-height: 140%;
        }

        footer {
            color: #333;
            font-size: 1rem;
            margin-bottom: 1.5rem;
            margin-right: 5%;
            margin-top: 1.2rem;
            text-align: right;
        }

        table,
        td {
            border: 1px solid #444;
            border-collapse: collapse;
            /* text-align: center; */
            height: 1.8rem;
        }

        .classItem {
            overflow: hidden;
            width: 100%;
        }

        .classItem .itemLeft {
            float: left;
            width: 50%;
        }

        .classItem .itemCont {
            width: 50%;
            float: left;
            text-align: center;
        }

        .classItem .itemCont .lag {
            font-size: 18px;
            margin-bottom: 10px;
            display: block;
        }

        .classItem .itemCont strong {
            display: block;
        }

        .classItem .itemInput {
            border: 2px solid;
            background: #F1F4FF;
            height: 30px;
            line-height: 30px;
            margin-bottom: 5px;
            width: 80%;
            float: right;
        }

        .classItem .itemInput label {
            width: 130px;
            font-size: 14px;
            background: #fff;
            font-weight: bold;
            text-align: center;
            display: block;
        }

        /* .classItem .itemInput label::before {
            content: '';
            height: 0;
            width: 10px;
            height: 10px;
            border: 1px solid;
            text-align: center;
            margin: 19px 0 -17px -16px;
        }

        .classItem .itemInput.cur label::before {
            background: #444;
        } */


        table td {
            color: #000;
            font-size: 12px;
        }

        table .item2 {
            background: #B8CCE4;
            color: #000;
            font-size: 12px;
        }

        table .custStyle {
            background: #DCE6F1;
            color: #000;
            font-size: 12px;
        }

        table .mystyle {
            color: #000;
            font-size: 12px;
        }

        table .mystyle span {
            margin-left: 20px;
        }
    </style>
</head>

<body>
    <div class="wrapBox">
        <div class="classItem">
                <div style="overflow:hidden; text-align: center;">
                        <img src=""
                            alt="" width="140" style="margin: 20px auto;" />
                            <strong class="lag" style="display: block; margin-bottom: 10px; font-size: 18px;">AUTHORIZATION AGREEMENT FOR RECURRING PAYMENT</strong>
            </div>
        </div>
        <style>
            .item{
                display: inline-block; width: 48%;
            }
            .spanTitle{
                font-size: 18px;
            }
            .myborder{
                background: #ccc; border: 1px solid #999; padding: 20px;
            }
        </style>

        <div><span class="spanTitle">Payment Date (Circle One) :</span></div>
        <div>
            <div class="item">
                <span class="spanTitle">Order Number</span>
            </div>
            <div class="item">
                <span class="spanTitle">Customer Name</span>
            </div>
            <div class="item">
                <span class="spanTitle">Phone</span>
            </div>
            <div class="item">
                <span class="spanTitle">Address</span>
            </div>
        </div>
        <br>
        <div class="myborder">
            <p><input type="checkbox"> Re-Enrollment - Exisiting Order No.</p>
            <p>I authorize COWAY USA, INC (referred to as "COWAY") to withdraw monthly payments, fees, and etc. from my existing ACH or Credit Card Recurring preregistered account. COWAY has my permission to save, store, and use this account information from the existing record enrolled under my name. By 
                signing this authorization, I agree to the recurring payments agreement policies listed below.)</p>
        </div>
        <br>
        <div style="border: 1px solid #ccc; height: 100px;"></div>
        <br>
        <div style="border: 1px solid #ccc; padding: 10px;">
            <h3>Automated Payment Agreement Policies</h3>
            <p>I hereby authorize COWAY USA, INC (referred to as "COWAY") to charge the fees associated with the services provided, including but not limited to 
                COWAY's monthly rental fees, adjustments, and/or any additional charges associated with your Coway account from the indicated credit card/bank 
                account provided above. If payment date is not indicated, payment will automatically be processed on the 10th of each month by default. If the 
                scheduled payment date falls on a weekend or holiday, the payment will be withdrawn on the following business day. I understand Coway is not 
                responsible for any bank fees, credit/debit card fees, or related fees that may be incurred on my account. I agree that periodic charge will be applied to 
                my account according to my COWAY billing cycle, and in order to cancel the recurring billing process, I am required to contact a month prior to the next 
                billing cycle to either cancel the associated COWAY account, or arrange for an alternative method of payment. By enrolling in an automatic payment 
                plan, I understand that COWAY will not mail me any invoices, statements, or bills. In the event of ACH transaction being returned by my bank for any 
                reasons, I understand that COWAY may at its discretion attempt to process the charge again and agree to an additional $10.00 returned item fees will 
                be charged per transaction. I agree that if I have any problems or questions regarding my account or any services provided by COWAY, I will contact 
                COWAY for assistance using the contact information provided below. I acknowledge that the origination of ACH transactions to my account must 
                comply with the provisions of U.S. law. I certify that I am an authorized user of this credit/debit card or bank account. By signing this authorization, I 
                request and authorize my bank or credit/debit card to accept that I am legally authorized to enter into this recurring credit card billing agreement with 
                COWAY.
                Electronic Copy; The parties to this document agree that a copy of the original signature (including an electronic copy) may be used for any and all 
                purposes for which the original signature may have been used. The parties further waive any right to challenge the admissibility or authenticity of this 
                document in a court of law based solely on the absence of an original signature.</p>
        </div>
        <p style="text-align: center; margin-top: 10px;">4221 WILSHIRE BLVD #210, LOS ANGELES, CA 90010</p>
            <p style="text-align: center; margin-top: 10px;">TEL: 213-386-3033, FAX: 323-549-0910 billing@coway-usa.com</p>
    </div>

</body>

</html>

<style>
    .SIGNATURE p {
        overflow: hidden;
        margin: 10px;
    }

    .SIGNATURE label {
        color: #000;
        display: inline-block;
        width: 200px;
        text-align: left;
        float: left;
        font-size: 12px;
    }
</style>